title: Surgical results in malignant glaucoma refractory to medical or laser therapy.
abstract: We investigated the surgical results in 25 patients identified with malignant (ciliary block) glaucoma. Four of these patients (16%) had successful outcomes following laser treatment alone. Nineteen patients (76%) underwent microsurgery for glaucoma refractory to conventional medical and/or laser therapy and are the subjects of this study. Core vitrectomy was successful in 4 of 6 pseudophakic patients (67%) and in 1 of 4 phakic patients (25%). Combined cataract extraction and vitrectomy had a higher success rate in patients undergoing posterior capsulectomy at the time of surgery (5 of 6 patients; 83%) compared with those patients left with an intact posterior capsular bag (1 of 4 patients; 25%). Intracapsular cataract extraction was successful in 1 of 2 patients (50%). We conclude that surgical vitrectomy in the presence of an intact posterior capsule may preclude the surgical resolution of aqueous misdirection. In eyes with pre-existing cataract, we recommend combined lens extraction, primary posterior capsulectomy and surgical vitrectomy for the surgical management of phakic malignant glaucoma.
authors.affiliation: Glaucoma Unit, Moorfields Eye Hospital, London, UK.
authors.forename: J C
authors.initials: JC
authors.lastname: Tsai
authors.forename: K A
authors.initials: KA
authors.lastname: Barton
authors.forename: M H
authors.initials: MH
authors.lastname: Miller
authors.forename: P T
authors.initials: PT
authors.lastname: Khaw
authors.forename: R A
authors.initials: RA
authors.lastname: Hitchings
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014821:Vitrectomy / Q000379:methods*